Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Anaesthetics and peri-operative care > Flashcards

Anaesthetics and peri-operative care Flashcards

1
Q

What parts of a cardiovascular history are particularly important in a pre-op assessment?

A

Previous MI - increased risk of further infarction
Poorly controlled hypertension - risk of ishcaemic event
Heart failure - increased morbidity and mortality
Angina frequency and severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is an airway assessmed pre-operatively?

A 
Is patient overweight
How far can their mouth open
Do they have a short neck or small mouth
Is there any soft tissue swelling
Any reduced flexion/extension of cervical spine
Mallampati criteria
Thyromental distance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an ASA grade 1?

A

Normal healthy individual without systemic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an ASA grade 2?

A

Person with mild to moderate systemic disease that doesn’t cause any limitation in activity eg treated hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an ASA grade 3?

A

Severe systemic disease imposing functional limitation on activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an ASA grade 4?

A

Incapacitating systemic disease which is a constant threat to life eg unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an ASA grade 5?

A

Moribund patient unlikely to survive 24 hours with or without surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What pre-op investigations should be done for minor surgery?

A

U&Es in older people or ASA3+ if at risk of AKI

ECG if over 40 or ASA 3+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What pre-op investigations should be done for intermediate surgery?

A

FBC is renal or cardiovascular disease
U&Es if at risk of AKI
LFTs and clotting if liver disease or on anticoagulants
ECG if cardiovascular, renal disease, or diabetes or ASA3+
?ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What pre-op investigations should be done for major or complex surgery?

A 
FBC
U&Es
Clotting and LFTs
ECG in most people
?Cross match/group and save
?ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is a group and save and when is a cross match done before surgery?

A

Group and save is if there maybe some blood loss but it is not routine for this procedure eg in appendicectomy
Cross match if blood loss is anticipated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 examples of minor surgery?

A

Release of peripheral nerve entrapment at the wrist
Tooth extraction
Excising skin lesion
Drainage of middle ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 3 examples of intermediate surgery

A

TOnsillectomy
Excising varicose veins
Arthroscopy
ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give 3 examples of major surgery

A 
Total joint replacement
Lung surgery
THyroidectomy
Organ transplantation
Excision of colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the body’s requirements for water and electrolytes?

A

30ml/kg/day of water
Roughly 1-2mmol/kg.day of sodium, potassium and chloride
50-100g per day of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is fluid resuscitation done?

A

500ml boluses in 15 mins of either Hartmann’s or normal saline, up to 2 litres as required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the composition of losses from vomit differ from plasma and what is the importance of this?

A

Has lower sodium and higher potassium and chloride. This means it puts pt at risk of hypochloraemic hypokalaemic alkalosis. This should be adjusted for in fluid management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do fluid losses from sweating impact on fluid management decisions?

A

Sweat has relatively low electrolytes so can predispose to hypernatraemia. Be careful not to overload with sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can post-op pain be minimised?

A

Pre-op counselling
Pre-emptive analgesia peri-operatively
Post-op analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name 3 methods of peri-operative pre-emptive analgesia?

A 
IV long acting analgesia
Local anaesthetic infiltration at wound edges
Regional nerve blocks
Epidural
IV/suppository NSAID before waking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What monitoring should be done in a patient with an epidural?

A

Look out of severe hypotension and respiratory depression (signs of toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the benefits of PCA?

A

Excellent continuous pain relief
Minimal sedation
Minimal respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give 5 complications that may manifest as excessive post-op pain

A 
Compartment syndrome
Haematoma
Infection
DVT
MI
Acute limb ischaemia
Haemorrhage
Anastamotic leak
Biliary leak
Abscess
Obstruction/ileus/constipation
Urinary retention
Bowel ischaemia
#NOF if fall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should mild-moderate post-op pain be managed?

A

Paracetamol
Cocodamol
Mild oral NSAID eg ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How should moderate post-op pain be managed?
Paracetamol Codeine/dihydrocodeine Oral/suppository stronger NSAID eg diclofenac
26
How should moderate-severe post-op pain be managed?
Moderate opiate eg oxycodone or tramadol IV NSAID eg diclofenac Oral slow release morphine PCA morphine/diamorphine
27
Give 5 causes of post-op shortness of breath
``` Acute bronchopneumonia Aspiration Lobar collapse Pneumothorax PE Atelectasis ARDS Abdominal distension Cardiac failure Hyperventilation ```
28
Give 5 conditions associated with the development of ARDS
``` Radiation pneumonitis Lung contusion Sepsis Severe acute pancreatitis Near-drowning Aspiration of gastric contents Inhalation of corrosive materials Fat, air, or amniotic fluid embolism Multiple trauma with shock Major head injury Massive blood transfusion DIC Eclampsia Cardiopulmonary bypass Severe allergic reactions Drug overdose ```
29
How does atelectasis occur?
Mucus is retained in the bronchi causing bronchial obstruction. Alveoli supplied by those bronchi collapse as air in them is reabsorbed Collapse of lung segments with reduced ventilation Secondary infection may occur
30
Give 3 patient factors increasing the risk of atelectasis
``` Obesity Pregnancy Smoker Muscular weakness Difficulty coughing ```
31
Give 3 treatment factors that increase the risk of developing atelectasis
``` Opiates Wound pain NG tube Irritant anaesthetic drugs Atropine ```
32
Give 5 features of atelectasis
``` Dyspnoea Tachycardia Pyrexia Cyanosis Painful cough Reduced chest expansion Basal dullness Reduced air entry Crepitations ```
33
How does atelectasis appear on an x ray?
Opacity
34
How is atelectasis managed?
Extensive chest physiotherapy Ensure adequate analgesia to aid mucus clearance Treat any secondary infection
35
What is acute respiratory distress syndrome?
Interstitial oedema and reduced ling compliance as a result of a lung injury. Causes large VQ mismatch and respiratory failure
36
How does ARDS occur?
Insult to lung raises the pulmonary capillary permeability, causing exudate of fluid into alveolar interstitium causng interstitial oedema and reduced lung compliance and so reduced ventilation Damage to alveolar cells also causes alveolar spaces to fill with fluid There is a VQ mismatch causing a large shunt On recovery, there is interstitial fibrosis
37
What are the clinical features of ARDS?
Rapid, shallow breathing Scattered crepitations Reduced PO2
38
What is the appearance of ARDS on chest x ray?
Progresses from normal to increase in interstitial markings to white out
39
How is ARDS managed?
``` ICU bed Ventilation with PEEP Monitor right atrial pressure TOE to monitor cardiac output Loop diuretics or haemofiltration to maintain negative fluid balance ```
40
Give 5 causes of post-op tachycardia
``` Anxiety Pain Atrial fibrillation Atrial flutter Infection Circulatory disturbance Thyrotoxicosis Hypovolaemic shock Haemorrhage Dehydration Cardiac failure MI Anastamotic leak ```
41
Give 5 causes of post-op pyrexia
``` Drug reaction Transfusion reaction Thyrotoxic crisis Phaeochromocytoma Malignant hyperthermia Malaria Central or peripheral line infection UTI Wound infection Pneumonia PE Haematoma Anastamotic leak DVT ```
42
What drugs commonly cause PONV?
Opiates Erythromycin Metronidazole
43
Give three causes of immediate PONV
``` Anxiety Gut handling Vestibular stimulation Oropharyngeal stimulation Hypotension Hypoxia Pain ```
44
What features of PONV may indicate bowel obstruction?
If there's sustained vomiting more than 2 days post-op
45
What are the two main causes of post-op oliguria?
Urinary retention | Reduced urinary production
46
Give 3 causes of post-op urinary retention
Pre-existing outlet obstruction Difficulty with passing urine supine Difficulty passing urine without privacy Overfilling of bladder due to accumulation of large urine volume during operation Transient disturbance of neurological control Wound pain inhibiting abdominal muscle contraction Specific surgery predisposing to retention Constipation
47
Which surgeries increase the risk of post-op urinary retention?
Abdominoperineal rectal resection | Bilateral inguinal hernia repair
48
How is post-op urinary retention managed conservatively?
Adequate analgesia Encourage mobility to be able to use commode/bottle or wheel to bathroom and give time alone Encourage bowel movements
49
How is post-op oliguria managed?
Conservatively Catheterisation Flush catheter if already in situ
50
What examination findings suggest urinary obstruction?
Palpable suprapubic mass | Dull to percussion
51
What are the common causes of reduced post-op urine production?
Reduced renal perfusion due to hypovolaemia Hypotension Cardiac failure MI
52
How is reduced post op urine production managed?
Catheterisation to monitor output | Fluid challenge if cause thought to be hypovolaemia
53
What are the two types of neuromuscular blockers?
Depolarising | Non-depolarising
54
Give an example of a depolarising neuromuscular blocker and explain its action
Suxamethonium | Causes depolarisation and then blocks repolarisation causing paralysis until is hydrolysed by cholinesterase
55
When is suxamethonium used?
RSI | Urgent tracheal intubation, esp if at high risk of aspiration
56
Give 3 side effects of suxamethonium
Limb girdle pain Malignant hyperpyrexia Prolonged apnoea if deficient in (pseudo)cholinesterase Raised intraocular pressure Histamine release Rise in potassium. Can be large in eg burns, crush injuries
57
Give an example of a non-depolarising neuromuscular blocker and explain its action
Atracurium | Blocks ACh's access to nicotinic receptors so cannot cause depolarisation
58
When are non-depolarising neuromuscular blockers used?
Non-urgent tracheal intubation | Maintenance of muscle relaxation after suxamethonium
59
How is neuromuscular blockade reversed?
By giving anticholinesterase eg neostigmine
60
Name 3 IV anaesthetic agents
Propofol Etomidate Sodium thiopentone Ketamine
61
What are the main benefits of propofol?
Rapid acting Rapidly wears off Metabolites don't accumulate so can be used for maintenance
62
Give 3 side effects of propofol
``` Involuntary movements Reduced cerebral blood flow Myocardial depression Pain on injection Hypotension Ventilatory depression ```
63
When is sodium thiopentone used?
For rapid sequence induction
64
What are the disadvantages of sodium thiopentone?
Causes significant myocardial depression | Rapidly accumulates so can't be used for maintenance
65
Which IV anaesthetic agents are safe in cardiovascular instability?
Etomidate | Ketamine
66
What is a major side effect of etomidate?
Adrenal suppression
67
Name three factors that increase MAC
``` Children Chronic alcohol use Chronic opioid use Hyperthermia Hyperthyroidim Hypernatraemia Raised catecholamines ```
68
Name three factors that reduce MAC
``` Old age or neonates Hypothermia Hypothyroidism Hyponatraemia Acute alcohol use Acute TCA use Acute opioid use Acute benzodiazepine use Pregnancy Anaemia Lithium ```
69
Name two inhaled anaesthetic agents
Isoflurane Desflurane Sevoflurane
70
Which inhaled anaesthetic agents allow rapid changes in depth of anaesthesia and why is this??
Desflurane Sevoflurane Have low solubility so changes in concentration rapidly change the depth and affect on brain
71
What is the benefit of adding adrenaline to a local anaesthetic?
Cause vasoconstriction reducing rate of absoprtion, reducing toxicity and increasing duration of action
72
What is the difference between APTT and PT?
APTT measures intrinsic pathway (9, 11, 12 and 10) | PT measures extrinsic pathway (1, 2, 7, 5, 10)
73
What is the action of heparin?
Activates antithrombin 3 to break down clots
74
How is the action of heparin reversed?
Protamine sulphate
75
What are the side effects of heparin?
Bleeding Osteoporosis Hyperkalaemia Thrombocytopenia
76
How is heparin monitored?
Unfractionated monitored with APTT
77
What is the action of warfarin?
Inhibitis vitamin k so reduces levels of vit K dependent factors (10, 9, 7, 2) and protein C
78
Give 3 side effects of warfarin
Purple toes Skin necrosis Haemorrhage Teratogenesis
79
What is the thromboprophylaxis regime for general surgery patients?
5000 units sc dalteparin night before surgery or intra-operatively Below knee AES Intermittent pneumatic compression boots in theatre
80
What is the thromboprophylaxis regime for vascular surgery patients?
5000 units sc dalteparin night before surgery or intraoperatively unless undergoing neck surgery, eg CEA Intermittent pneumatic compression stockings on individual basis
81
What is the thromboprophylaxis regime for endocrine surgery patients?
Below knee AES
82
Name 3 contraindications to the use of LMWH
Recent cerebral haemorrhage Haemophilia Severe hypertension Acute bacterial endocarditis
83
Give 3 contraindications to the use of anti-embolic stockings
``` Peripheral arterial disease Peripheral neuropathy Fragile skin Cardiac failure Pulmonary oedema secondary to congestive heart failure Severe leg oedema ```
84
Name 3 benefits of surgical antibiotic prophylaxis
Reduces incidence of surgical site infections Minimises affect on patients host defences Reduces adverse effects Reduces effects on patient's normal bacterial flora
85
What antibiotic prophylaxis is used in vascular surgery?
3 doses of co-amoxiclav or teicoplanin and gentamicin
86
What antibiotic prophylaxis is given in abdominal surgery?
If upper GI, coamoxiclav or teicoplanin + gentamicin | If lower, metronidazole +/- gentamicin
87
Name two operations that are particularly at risk of post-op haemorrhage
THyroidectomy Parathyroidectomy Angiography Laparoscopic surgery with pfannenstiel incision
88
What is the cause of reactive post-op bleeding?
Usually bleeding from a slipped ligature or a vessel that was missed due to hypotension induced vasoconstriction. Bleeding will only occur once BP normalises
89
What is the main cause of secondary post-op bleeding?
Erosion of a vessel due to a spreading infection
90
What are the 3 peak times of operative haemorrhage?
Primary occurs intraoperatively Reactive occurs within 24 hours Secondary usually occurs after 7-10 days
91
What is the difference between a provoked and an unprovoked VTE?
Provoked VTEs are associated with a transient risk factor that can easily be removed Unprovoked VTEs occur in the absence of a transient risk factor so there may either be no risk factor or there may be one that is persistent and not easily correctable eg cancer
92
What are the clinical features of a DVT?
Swelling and pain in the leg Altered skin colour and temperature Vein distension Tenderness
93
What advice should be given to the patient after a DVT has resolved?
To increase walking exercise | To keep leg elevated whilst sitting
94
What is post-thrombotic syndrome of the leg?
A complication of a DVT with chronic venous hypertension, leading to pain, swelling, dermatitis, hyperpigmentation, ulceration and lipodermatosclerosis

Surgery (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions